Review Article

Point-of-Care Sinus Ultrasound: Impact Within a Large Internal Medicine Clinic and Review of Technique

Authors: David M. Tierney, MD, Joshua S. Becker, MD, Bryan D. Post, MD, Terry K. Rosborough, MD

Abstract

Outpatient diagnosis of acute bacterial sinusitis, using only traditional physical examination and clinical criteria, results in the overuse of antibiotics in patients with upper respiratory complaints. Point-of-care maxillary sinus ultrasound is easy to learn and quick to perform in a primary care clinic. The technique can reduce antibiotic prescribing by reassuring both patients and providers of the absence of fluid in the sinus, the hallmark of maxillary sinusitis. A review of the literature, description of technique, and results of sinus ultrasound implementation in a large internal medicine clinic are included.

 

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Centers for Disease Control and Prevention. National Center for Health Statistics. Ambulatory care use and physician office visits-National Ambulatory Medical Care Survey, 2014. https://www.cdc.gov/nchs/data/ahcd/namcs_summary/2014_namcs_web_tables.pdf. Accessed January 23, 2018.
 
2. Rosenfeld RM. Clinical practice. Acute sinusitis in adults. New Engl J Med 2016;375:962-970.
 
3. Sharp HJ, Denman D, Puumala S, et al. Treatment of acute and chronic rhinosinusitis in the United States, 1999-2002. Arch Otolaryngol Head Neck Surg 2007;133:260-265.
 
4. Sharma P, Finley R, Weese S, et al. Antibiotic prescriptions for outpatient acute rhinosinusitis in Canada, 2007-2013. PLoS One 2017;12:e0181957.
 
5. Schroeck JL, Ruh CA, Sellick JA, et al. Factors associated with antibiotic misuse in outpatient treatment for upper respiratory tract infections. Antimicrob Agents Chemother 2015;59:3848-3852.
 
6. Jørgensen LC, Friis Christensen S, Cordoba Currea G, et al. Antibiotic prescribing in patients with acute rhinosinusitis is not in agreement with European recommendations. Scand J Prim Health Care 2013;31: 101-105.
 
7. Gulliford MC, Dregan A, Moore MV, et al. Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices. BMJ Open 2014;4:e006245.
 
8. Gill JM, Fleischut P, Haas S, et al. Use of antibiotics for adult upper respiratory infections in outpatient settings: a national ambulatory network study. Fam Med 2006;38:349-354.
 
9. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA 2016;315:1864-1873.
 
10. Dekker AR, Verheij TJ, van der Velden AW. Inappropriate antibiotic prescription for respiratory tract indications: most prominent in adult patients. Fam Pract 2015;32:401-407.
 
11. Centers for Disease Control and Prevention. Antibiotic use in the United States, 2017: progress and opportunities. https://www.cdc.gov/antibiotic-use/stewardship-report/outpatient.html. Accessed January 18, 2018.
 
12. Williams JW, Simel DL. Does this patient have sinusitis? Diagnosing acute sinusitis by history and physical examination. JAMA 1993;270: 1242-1246.
 
13. Varonen H, Kunnamo I, Savolainen S, et al. Treatment of acute rhinosinusitis diagnosed by clinical criteria or ultrasound in primary care. A placebo-controlled randomised trial. Scand J Prim Health Care 2003;21:121-126.
 
14. Teppo H, Revonta M. Ultrasound device helps in ruling out maxillary sinus fluid in acute rhinosinusitis: how we do it. Clin Otolaryngol 2011;36:491-494.
 
15. Fufezan O, Asavoaie C, Cherecheş Panta P, et al. The role of ultrasonography in the evaluation of maxillary sinusitis in pediatrics. Med Ultrason 2010;12:4-11.
 
16. Varonen H, Mäkelä M, Savolainen S, et al. Comparison of ultrasound, radiography, and clinical examination in the diagnosis of acute maxillary sinusitis: a systematic review. J Clin Epidemiol 2000;53:940-948.
 
17. Gianoli GJ, Mann WJ, Miller RH. B-mode ultrasonography of the paranasal sinuses compared with CT findings. Otolaryngol Head Neck Surg 1992;107(6 Pt 1):713-720.
 
18. Pelikan Z. Part III. Clinical Disease. In: Gershwin ME, Incaudo G, eds. Diseases of the Sinuses: A Comprehensive Textbook of Diagnosis and Treatment. New York: Springer Science & Business Media; 2012:134-150.
 
19. Varonen H, Rautakorpi UM, Huikko S, et al. Management of acute maxillary sinusitis in Finnish primary care. Results from the nationwide MIKSTRA study. Scand J Prim Health Care 2004;22:122-127.
 
20. Gwaltney JM, Jr Phillips CD, Miller RD, et al. Computed tomographic study of the common cold. N Engl J Med 1994;330:25-30.
 
21. Chow AW, Benninger MS, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis 2012;54:e72-e112.
 
22. Lichtenstein D, Biderman P, Meziè G, et al. The “sinusogram,” a real-time ultrasound sign of maxillary sinusitis. Intensive Care Med 1998;24:1057-1061.
 
23. Vargas F, Boyer A, Bui HN, et al. A postural change test improves the prediction of a radiological maxillary sinusitis by ultrasonography in mechanically ventilated patients. Intensive Care Med 2007;33:1474-1478.
 
24. van Zanten AR, Dixon JM, Nipshagen MD, et al. Hospital-acquired sinusitis is a common cause of fever of unknown origin in orotracheally intubated critically ill patients. Crit Care 2005;9:R583-R590.
 
25. American Board of Internal Medicine Foundation. Choosing Wisely. http://www.choosingwisely.org. Accessed March 21, 2018.
 
26. Sharp AL, Shen E, Kanter MH, et al. Low-value antibiotic prescribing and clinical factors influencing patient satisfaction. Am J Manag Care 2017;23:589-594.
 
27. Bhattacharyya N, Kepnes LJ. Patterns of care before and after the adult sinusitis clinical practice guideline. Laryngoscope 2013;123: 1588-1591.